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The Hedgehog Review: Vol. 16 No. 3 (Fall 2014)

Post-Prozac Pathography

Joseph E. Davis

Reprinted from The Hedgehog Review 16.3 (Fall 2014). This essay may not be resold, reprinted, or redistributed for compensation of any kind without prior written permission. Please contact The Hedgehog Review for further details.

The Hedgehog Review: Fall 2014

Another “pathography” has recently appeared on the bestseller lists. No, it’s not the Kitty Kelley-style of biography that aims to demean its subject. The motifs of such books, according to the writer Joyce Carol Oates, who dubbed them pathographies, “are dysfunction and disaster, illnesses and pratfalls, failed marriages and failed careers, alcoholism and breakdowns and outrageous conduct.” The bestseller in this instance—Scott Stossel’s My Age of Anxiety—belongs to that genre of pathography written (usually) by sufferers themselves, in their own voices, reflecting on their illnesses and their efforts to get well, a genre that during the last two decades has included such bestsellers as Gilda Radner’s It’s Always Something, William Styron’s Darkness Visible, Susanna Kaysen’s Girl, Interrupted, Elizabeth Wurtzel’s Prozac Nation, Kay Redfield Jamison’s An Unquiet Mind, and Andrew Solomon’s The Noonday Demon.

Such first-person accounts need to be distinguished from two other popular genres that have also been called pathographies. One is the case history, a description of patient illness or disease written by a doctor or other professional. Hippocrates introduced this ancient form, and the term pathography originally had this meaning. The fascinating books of Oliver Sacks, such as The Man Who Mistook His Wife for a Hat, are contemporary examples. The second genre is psychobiographies, which are psychological studies of the lives of notable people. Sigmund Freud’s Leonardo da Vinci and a Memory of His Childhood, which Freud referred to as a pathography, is a classic of this type. But accounts written by patients themselves are a literary form of their own, reflecting in their changing styles important cultural norms and values, social expectations and attitudes toward medicine.

Stossel’s pathography tells the story of this successful editor’s myriad fears and phobias. It stands in a long line of pathographies dealing with what we would call psychological problems, a line dating to at least the eighteenth century and such works as George Cheyne’s personal account of melancholia, The English Malady. By contrast, most book-length autobiographical accounts of physical illness date from around the 1920s, when the first “sanatorium narratives” written by embittered tuberculosis patients began to appear. While pre-twentieth-century pathographies were likely to be part of spiritual autobiographies, popular pathographies of both physical and mental illness are now presented in the context of encounters with medicine: hospitals and other institutions, doctors and other practitioners, treatments both conventional and alternative. The changing styles of pathography often reflect this encounter, as well as the dominant cultural metaphors and archetypal myths on which they draw.

My Age of Anxiety has elements both old and new. Such common pathographic archetypes as quest, battle, and even rebirth are all on display. Stossel is on a “quest to understand,” engaged in a “battle” against his anxiety, which often “defeats” him. He ends by awakening to the possibility of some “redemptive quality or mitigating benefit” to his anxiety. The author’s intent is also conventional. First, as in many pathographies, the writing is motivated by an expectation of therapeutic benefit. Stossel is trying to come to terms with his anxiety and shame about it, hoping the very act of narrating will constitute its own form of healing. Second, following a typical claim in the pathographic literature, he offers his writing as vicarious support to others. Sharing his story is “an opportunity to provide solace to some of the millions of others who share this affliction.” But like many pathographies, past and present, Stossel’s book is only part memoir. It also has a more explicitly didactic purpose. It is a “study of anxiety” that aims, through its mix of mini-psychobiographies and summaries of scientific research, to provide solace of another kind.

What distinguishes this book is not its metaphors and myths but its revelations about our current situation. Scholars have argued that the popularity of pathographies is fueled in part by a reaction to the biomedical model, with its exclusively physical understanding of illness. Pathographies are said to offer the excluded patient’s voice. Not here. Stossel is a type of what the British have called an “expert patient,” a paraprofessional identity which biomedicine itself has been promoting for some time.

What he tells of his experience and how he tells it is woven into an extended brief in support of biological psychiatry. The solace he offers those who share “this affliction” is that anxiety—consistent with what he presents as the “modern scientific understanding”—has no reasons. The terror, despair, mortification, breakdowns, nervousness, stomach ailments, and other problems that he describes are simply a feature of his faulty neurochemistry. He says this neurochemistry, this “genotype of pathology,” is something he inherited, establishing his claim through a psychobiography of his great-grandfather and—over their objections—his mother and sister.

As further proof of his affliction’s strictly biological character, Stossel points to decades of various kinds of psychotherapy that have brought him little benefit. His successive therapists, who serve as foils throughout the book, are pleasant, reasonable people who want to help, who even promise cures. But all of them cling to what he considers to be an outmoded and unscientific outlook. His only relief, when he gets any relief, comes from drugs.

The doctors who prescribe those drugs—and Stossel has tried quite a few—are mentioned only in passing. He does not suggest that he has learned anything from them, though they explain his condition as the result of a chemical imbalance, an interpretation that Stossel comes around to endorse. His experience with the drugs themselves has been a slog, any remission only temporary or partial. Lauren Slater, in her widely read Prozac Diary, gives what she calls a “miracle-tinged description” of her experience on Prozac. Not Stossel. His attitude toward drugs is unsentimental, decidedly “post-Prozac” in terms of his enthusiasm for them. Lightly sprinkling in skepticism, he makes it clear that he is not beholden to medical authority. He is making his own judgments, questioning everything, taking responsibility for his own health, and engaging professionals as collaborators. He is reflexive, informed of the latest scientific findings, and active—precisely what “expert patients” in the age of chronic conditions, are enjoined to be. But what the expert patient represents is a patient who thinks like an expert. This identity is congenial with biomedicine precisely because it collapses the distance between itself and biomedical authority, an authority residing not in individual practitioners but in the latest findings out of Hopkins and Harvard. The real skepticism is directed toward whatever doesn’t meet this standard.

My point is not to trivialize Stossel’s experience or the experience of mental illness more generally. But My Age of Anxiety is not exactly a book about mental illness. Its subject is anxiety, a remarkably heterogeneous concept that Stossel discusses across a spectrum from the crippling to the everyday. Even in relating his experiences with anxiety, Stossel alternates between minimizing its effects and describing it as overpowering. Despite his many and intense fears and regular breakdowns, for instance, he never seems to need the help of his friends, co-workers, or family. In his dramatic opening story of his wedding, to give one example, he reports getting married in front of nearly 300 people and surprising those closest to him when he began to show signs of distress. Really? A person with a long-standing anxiety disorder? Throughout the book, something doesn’t quite square. There is lots of talk of internal states of distress but little of public consequences, or at least consequences that some Xanax and booze can’t address. What, precisely, is going on here? A clue comes from the most dramatic story of all. This is a story not about his anxiety but a malfunctioning toilet that soils his clothes and leads to a humiliating, pant-less dash for his room. On that dash, he tells us, he runs into John F. Kennedy, Jr., and that bit of name-dropping seems to suggest a deeper, if perhaps inadvertent, point of this pathography: that it’s also about the self in a meritocracy.

Not that Stossel ever says this. His talk about genetics and neurochemistry is talk about the body detached from social and cultural context. Not only are the therapists out of touch, in his view, so are the social critics who focus on problematic features of the contemporary self-society nexus. Yet surely the appeal of his story and his argument is that Stossel is a success—not of the celebrity kind but of the Harvard-trained professional kind. He has all sorts of problems, some versions of which, whether anxiety- or depression-related, are now quite common among the elites of our society. The schools of the Ivy League, for instance, can’t beef up their counseling and psychiatric services fast enough.

But Stossel has still risen, despite his problems and apparently by his own wits and effort, to be the editor of The Atlantic. His status means that all is as it should be. In her study of somatic pathographies, Reconstructing Illness, Anne Hunsaker Hawkins argues that before trust began to erode in the 1970s, postwar pathographies were nearly always of a testimonial variety, casting medicine in a positive light. Stossel’s is a testimonial of a different kind. If, according to his biological account, anxiety has no meaning, then his account does the consoling work of ruling out other, less palatable, explanations for personal problems, and offers a kind of absolution. At the same time, if meaningless, all the anxiety going around cannot be a sign of problems with our regime of individualism and social aspiration. That regime is not at fault, either. No worries here: Nothing is broken.

— Joseph E. Davis

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